CORRECTIVE REPRINT
PRIOR PRINTER'S NO. 507
PRINTER'S NO. 564
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
289
Session of
2023
INTRODUCED BY KRAJEWSKI, DALEY, KINSEY, ISAACSON, HOHENSTEIN,
CIRESI, SCHLOSSBERG, MADDEN, RABB, SANCHEZ, HOWARD, FREEMAN,
FRANKEL AND N. NELSON, MARCH 20, 2023
REFERRED TO COMMITTEE ON HEALTH, MARCH 20, 2023
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for enrolled dependents right to confidentiality for health
care services received.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.9. Enrolled Dependents Right to Confidentiality
for Health Care Services Received.--(a) A health insurance
policy or government program that is offered, issued or renewed
in this Commonwealth shall include policies and procedures that
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comply with Federal and State law to ensure that all
identifiable information regarding receipt of health care
services by a protected enrolled dependent is adequately
protected and remains confidential.
(b) A health insurer shall develop a standardized
confidential communications request form, in an easily readable
and understandable format as approved by the department, to
permit a protected enrolled dependent to request an alternative
method for receiving confidential communication related to the
receipt of health care services. The following apply:
(1) A health insurer shall permit any protected enrolled
dependent to submit a confidential communications request.
(2) A request by a protected enrolled dependent exercising
the option for confidential communication shall be submitted in
writing using the standardized form.
(3) The availability of the standardized form shall be
disseminated in a health insurance policy or government program.
(c) Confidential communications subject to the requirements
of this section include the following:
(1) an explanation of benefits;
(2) information related to an appointment for health care
services;
(3) a claim denial;
(4) a request for additional information related to a claim;
(5) a notice of a contested claim;
(6) the name and address of a provider, a description of
services provided and other visit information; and
(7) any written, oral or electronic communication from a
carrier that contains protected health information.
(d) Alternative methods of receiving confidential
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communication shall include:
(1) sending a paper form to an alternate address as
requested by the protected enrolled dependent;
(2) sending electronic communication to an alternate
electronic address as requested by the protected enrolled
dependent; or
(3) withholding confidential communication as requested by
the protected enrolled dependent until an alternate method of
receiving communication is requested subsequently at a later
date by the protected enrolled dependent. A protected enrolled
dependent shall be permitted to submit a subsequent request
orally in-person or by telephone, or by paper or electronic
written communication.
(e) If a protected enrolled dependent has no liability for
payment for a procedure or service, a health insurance policy or
government program shall permit a protected enrolled dependent
to request suppression of all confidential communications, in
which case the explanation of benefits, or any confidential
communication covered under this section, shall not be issued.
(f) A health insurer or government program shall ensure that
requests for confidential communication required under
subsection (b) are implemented not later than three business
days after receipt of a request. A health insurer shall
acknowledge receipt of a protected enrolled dependent's
confidential communications request form by providing notice to
the protected enrolled dependent through the alternative method
of communication as requested by the protected enrolled
dependent.
(g) The department, in collaboration with the Department of
Health, may develop and implement a plan to educate health care
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providers and consumers regarding the rights of protected
enrolled dependents and the responsibilities of health insurers
to promote compliance with this section. The following apply:
(1) The plan shall include staff training and other
education for:
(i) All administrative staff involved in patient
registration and confidentiality education.
(ii) All billing staff involved in processing insurance
claims.
(iii) Education for health care providers employed in a
health care facility as defined in section 802.1 of the act of
July 19, 1979 (P.L.130, No.48), known as the "Health Care
Facilities Act."
(iv) Education for health care providers employed in school
health services as provided under Article XIV of the act of
March 10, 1949 (P.L.30, No.14), known as the "Public School Code
of 1949."
(2) The plan shall include instruction for health care
providers to disseminate a protected enrolled dependent's right
to exercise the alternative delivery of confidential
communications in a manner that clearly displays its
availability to patients.
(h) The department may promulgate regulations necessary to
implement and enforce this section, which may include
requirements for reasonable reporting by a health insurer that
issues, delivers, executes or renews a policy covered under this
section to the department regarding compliance and the number
and type of complaints received regarding noncompliance with
this section.
(i) The department shall submit an annual report to the
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chairperson and minority chairperson of the Banking and
Insurance Committee of the Senate and the chairperson and
minority chairperson of the Insurance Committee of the House of
Representatives, which shall be made available on the
department's publicly accessible Internet website, to
disseminate the following information:
(1) Aggregate data for health insurer reporting requirements
as established under subsection (h).
(2) The effectiveness of the requirements established under
this section in enabling protected enrolled dependents to
request an alternative method for receiving confidential
communications.
(3) Education and outreach conducted by health insurers and
providers to inform protected enrolled dependents about their
right to request an alternative method for receiving
confidential communication related to the receipt of health care
services.
(j) The department shall implement an appeals process for
the denial or partial denial by a health insurer of a claim
provided to a protected enrolled dependent who has exercised the
right to an alternative method for receiving confidential
communications covered by this section. The following apply:
(1) A protected enrolled dependent has the right to appeal a
denial or partial denial of a claim.
(2) An enrollee, subscriber or certificate holder is
prohibited from appealing a denial or partial denial of a claim
unless the protected enrolled dependent has provided written
authorization to disclose claims information relevant to the
appeal.
(k) This section applies as follows:
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(1) For a health insurance policy or government program for
which either rates or forms are required to be filed with the
Federal Government or the department, this section applies to a
policy for which a form or rate is first permitted to be used
180 days on or after the effective date of this section.
(2) For a health insurance policy or government program for
which neither rates nor forms are required to be filed with the
Federal Government or the department, this section applies to a
policy issued or renewed on or after 180 days after the
effective date of this section.
(l) The following words and phrases when used in this
section shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
"Department." The Insurance Department of the Commonwealth.
"Government program." Any of the following:
(1) Medical assistance under Subarticle (f) of Article IV of
the act of June 13, 1967 (P.L.31, No.21), known as the "Human
Services Code."
(2) The Comprehensive Program for Health Care for Uninsured
Children under Article XXIII-A.
"Health care practitioner." An individual who is authorized
to practice some component of the healing arts by a license,
permit, certificate or registration issued by a Commonwealth
licensing agency or board.
"Health care provider." Any of the following:
(1) A health care practitioner as defined in section 103 of
the "Health Care Facilities Act."
(2) A federally qualified health center as defined in 42
U.S.C. § 1395x(aa)(4) (relating to definitions).
(3) A rural health clinic as defined in 42 U.S.C. §
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1395x(aa)(2).
(4) A pharmacist who holds a valid license under the act of
September 27, 1961 (P.L.1700, No.699), known as the "Pharmacy
Act."
(5) A social worker, clinical social worker, marriage and
family therapist or professional counselor who holds a valid
license under the act of July 9, 1987 (P.L.220, No.39), known as
the "Social Workers, Marriage and Family Therapists and
Professional Counselors Act."
(6) A registered professional nurse who holds a valid
license under the act of May 22, 1951 (P.L.317, No.69), known as
"The Professional Nursing Law."
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
subscriber contract, certificate or plan that provides medical
or health care coverage for services provided by a health care
facility or licensed health care provider on an expense-incurred
service or prepaid basis and that is offered by or is governed
under any of the following:
(i) This act, including section 630.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Chs. 61 (relating to hospital plan
corporations) and 63 (relating to professional health services
plan corporations).
(2) The term does not include:
(i) Accident only.
(ii) Credit only.
(iii) Long-term care or disability income.
(iv) Specified disease.
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(v) Medicare supplement.
(vi) TRICARE , including Civilian Health and Medical Program
of the Uniformed Services (CHAMPUS) supplement.
(vii) Fixed indemnity.
(viii) Dental only.
(ix) Vision only.
(x) Workers' compensation.
(xi) Automobile medical payment insurance under 75 Pa.C.S.
(relating to vehicles).
(xii) Hospital indemnity.
(xiii) Limited benefits.
"Health insurer." An entity offering a health insurance
policy or government program.
"Protected enrolled dependent." Any of the following:
(1) An adult covered as a dependent on a health insurance
policy.
(2) A minor authorized to consent to medical, dental and
health services under State law that is covered as a dependent
on a policyholder's insurance policy.
"Protected health information." As defined in Federal
regulation under 45 CFR 160.103 (relating to definitions)
promulgated under the administrative simplification provisions
of the Health Insurance Portability and Accountability Act of
1996 (Public Law 104-191, 110 Stat. 1936).
Section 2. This act shall take effect in 60 days.
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